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Confronting Oregon’s Substance Use and Addiction Crisis

Last week I participated on a panel sponsored by the Oregon Health Forum to address the question: How can we fix Oregon’s addiction services system?” I joined Dr. Rachael Solotaroff, CEO of Central City Concern, Maree Wacker, CEO of De Paul Treatment Centers, and Mike Marshall, co- Founder and Director of Oregon Recovers, a new coalition united to create a world class system of prevention, treatment and recovery support for Oregonians suffering from the disease of addiction. Substance use disorder and addiction has become a serious public health crisis in Oregon that is undermining every aspect of our society and extracting a huge fiscal and human toll.

A few days ago, I posted a piece on the study of Adverse Childhood Experiences (ACEs), which documented the strong correlation between the level of traumatic stress in childhood and poor physical, mental and behavioral outcomes later in life. One of the most pervasive and powerful ACEs is substance abuse and addiction within a family. Why? Because substance use disorder is a primary root cause of family instability, the loss of children to foster care, homelessness, unemployment and involvement with the criminal justice system. In short, substance use disorder and addiction is not only a major adverse childhood experience in itself, it contributes to many other forms of childhood trauma.

As a consequence, substance use disorder and addiction has become a public health crisis: a progressive chronic disease that afflicts millions of people and negatively impacts all aspects of our society. The systemic burden of untreated substance use disorder is enormous, costing Oregon almost $3 billion a year. Individuals with substance abuse disorders show up on our streets, in emergency rooms, jails and the child welfare system—and are associated with lost productivity; child abuse and neglect; and premature death.

The ACE study shows the value of true primary prevention. It is profoundly logical to invest in preventing and treating substance abuse disorders from both a fiscal and a societal standpoint; and the fact that we have not done so is one of the greatest frustrations and contradictions in American public policy—and the problem is largely a political one. In our legislative budget process, we tend to fund what is visible, compelling, immediate. That is, we prioritize immediate problems over investments that could prevent those problems in the first place. For example, if given a choice between funding prenatal care—or paying to resuscitate a 500-gram infant in the neonatal intensive care unit—the emotional and political imperative always puts money into the hospital rather than into the community. To policy makers, the neonate is highly visible while the thousands of women who lack prenatal care are anonymous and therefore invisible from the standpoint of public policy and budgeting.

That is exactly what happens when it comes to the public health crisis of substance use disorder and addiction. Both our political system and our health care system view this not as a chronic progressive disease, but as an acute problem that requires only episodic treatment. This view, coupled with the stigma that is, unfortunately, with this disease, has led to the lack of health care coverage for long term treatment and recovery support, inadequate funding across the board a workforce crisis.

How do we turn this around? We turn it around by building a new political constituency. Because our political system tends to fund after-the-fact acute crisis interventions, we need to build a political constituency for investments that address root causes; investments that can prevent the need for those crisis interventions in the first place.

That is what Oregon Recovers is all about. It is a call to action. It is a call for political leadership that has the courage to recognize substance abuse disorder and addiction for what it is: a serious public health crisis that is extracting a huge fiscal and human toll on our state; a crisis that deserves and equally serious response.

It is a call for leadership in the health sector that has the courage to recognize that our current approach to addiction must be transformed— that tweaking the system is not enough—because the current system was built on stigma, on the view that substance abuse is not a chronic, progressive disease but an acute problem that requires only episodic treatment.

And it is a call to action by everyone who advocates in the political process, regardless of what political constituency you may identify with. Whether you are an advocate for education, for early childhood, for reducing the cost health care, for full employment, for those in poverty, or for criminal justice reform—substance use disorder and addiction contribute to the problem you are trying to solve; make the problem more difficult and more expensive to solve; and undermines the effectiveness of your advocacy.

Recover Oregon recognizes that these issues are all interrelated and that it is time for the creation of a new broad-based political constituency for the development of an integrated, recovery-oriented system of care that addresses prevention, intervention, treatment and recovery support. This is the first step toward making such a system a reality.

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John Kitzhaber has over forty years of experience in health policy and politics in both the public and private sectors. He authored the groundbreaking Oregon Health Plan and was the chief architect of Oregon’s Coordinated Care Organizations. In 2013 Modern Healthcare Magazine ranked John #2 on list of the “100 Most Influential People in Health Care;” and #1 on the list of the “50 Most Influential Physician Executives.